Postcardiotomy extracorporeal life support (ECLS) is a resource-demanding therapy
with varied results among institutions. An organized protocol was necessary to improve
the effectiveness of this therapy.
A total of 110 patients received ECLS due to refractory postcardiotomy cardiogenic
shock between January 2003 and June 2009, and were eligible for inclusion in this
retrospective study. Preoperative, perioperative, and postoperative variables were
collected, including the European system for cardiac operative risk evaluation (EuroSCORE)
and markers of ECLS-related organ injuries. All variables were analyzed for possible
associations with mortality in hospital, and after hospital discharge. The mean age,
additive EuroSCORE, and left ventricular ejection fraction (LVEF) for all patients
was 60 (+/-14) years, 9 (+/-6), and 43% (+/-20%) respectively. Sixty-seven patients
were weaned from ECLS and 46 survived to hospital discharge. The mean duration of
ECLS support was 143 h (+/-112 h). Multivariate analysis revealed that an age of >60
years, a necessity for postoperative continuous arteriovenous hemofiltration, a maximal
serum total bilirubin >6 mg/dL, and a need for ECLS support for >110 h were independent
predictors of in-hospital mortality. In addition, persistent heart failure with LVEF
<30% was an independent predictor of mortality after hospital discharge. A risk-predicting
score for in-hospital mortality associated with postcardiotomy ECLS was developed
for clinical application.
Based on the abovementioned findings, a comprehensive protocol for postcardiotomy
ECLS was designed. The primary objective was to achieve adequate hemodynamics within
the first 24h of initiating ECLS. Other objectives of the protocol included a consistent
approach to safe anticoagulation while on ECLS, a process to make decisions within
7 days of initiating ECLS, and patient follow-up after hospital discharge.
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